Comparative randomized evidence specifically evaluating totally extraperitoneal (TEP) and Lichtenstein repair is limited. This study compared sex-related and general health-related quality of life following these two techniques. In this prospective randomized controlled trial, sexually active adult men with primary uncomplicated inguinal hernias were randomized to TEP or open Lichtenstein repair. The primary endpoint was pain during sexual activity at 1 year, measured using the Sexual Inguinal Hernia Questionnaire (SexIHQ). Secondary outcomes included additional SexIHQ domains and health-related quality of life measured by the 36-Item Short Form Health Survey (SF-36). A total of 105 patients were analyzed, including 50 undergoing TEP and 55 undergoing open repair. Baseline demographic, clinical, SF-36, and SexIHQ measures were comparable between groups. At 1 year, pain during sexual activity was reported less frequently after TEP than after open repair (16.0% vs. 43.6%; risk ratio 0.37, 95% CI 0.18-0.74; p = 0.003). Among patients reporting pain during sexual activity, the degree of impairment in sexual activity did not differ significantly between groups. SF-36 scores at 1 year were significantly higher after TEP across all measured domains. TEP repair was associated with a lower rate of pain during sexual activity at 1 year compared with Lichtenstein repair. However, other SexIHQ domains were not significantly different. These findings suggest a possible benefit of avoiding anterior inguinal canal dissection, but do not establish broad superiority of TEP for overall sexual function.
Individuals living in Residential Aged Care Facilities (RACFs) have the right to sexual safety and to be protected from all forms of unwanted sexual behaviour. Emerging evidence suggests that sexual safety breaches can occur within aged care settings, placing vulnerable residents at risk. Aged care workers have a significant role in ensuring their sexual safety and protection. This study aimed to explore the perspectives and experiences of aged care workers regarding the sexual safety of aged care residents. The study used an exploratory qualitative descriptive design. Data were collected from 22 participants (n = 14 nurses and n = 8 personal care workers) across various RACFs in Australia through semistructured interviews. Data were analysed using thematic analysis. Five major themes derived from the study include the following: sexual safety matters: perspectives on sexual safety, dimensions of sexual vulnerability, it was just seen as behaviour: implications for identification and escalation, perceived barriers and building sexual safety through shared ownership. Findings highlight gaps in sexual safety knowledge, reporting practices and workforce preparation within residential aged care, with cultural and personal backgrounds influencing perceptions and responses to sexual safety incidents. Strengthening leadership, tailored mandatory sexual safety education and clear reporting pathways are essential to support a sexually safe environment while upholding residents' sexual autonomy and rights. Findings suggest that nursing management should prioritise the implementation of tailored sexual safety education, strengthen organisational reporting systems and support workforce capability in recognising and responding to sexual safety incidents. Leadership approaches that foster consistent reporting practices and uphold residents' sexual autonomy may contribute to safer residential aged care environments.
Research on gender differences in self-stigma among individuals with psychosis is limited. Gender differences have been found in factors associated with self-stigma, such as self-esteem, quality of life, and cognitive insight. This study aimed to determine predictors of self-stigma reduction in men and women after receiving Metacognitive Training (MCT) or a combined intervention delivering MCT alongside cognitive rehabilitation. Randomized clinical trial with two intervention branches. Participants were randomly allocated to one of two conditions: MCT or MCT alongside cognitive rehabilitation. Assessments were carried out before and after the intervention by blinded professionals. Linear mixed models, correlation analyses, and regressions were employed to examine the effect of treatment, relationships between variables, and potential predictors of treatment response in both groups for men and women, respectively. Self-stigma was reduced in both intervention groups, with no significant differences between them, suggesting both interventions were effective. Descriptive analyses revealed women reported higher self-stigma (n = 37, M = 63.78, SD = 14.01) than men (n = 40, M = 59.40, SD = 14.52). Regression analyses suggest that post-treatment self-stigma was predicted by different predictors according to sex. In women, self-esteem (R2 = 0.25, β = -2.31, p = 0.023) was a significant predictor of post-treatment self-stigma, while in men, quality of life significantly predicted self-stigma scores post-treatment (R2 = 0.37, β = -0.62, p < 0.001). Cognitive insight was not a significant predictor for either sex. Distinct pathways of self-stigma recovery emerged for women and men, underscoring the need for gender-sensitive interventions. These findings underscore the need for tailored stigma-reduction interventions that consider gender-specific factors influencing mental health outcomes. Longitudinal research should assess durability and further clarify gender-related mechanisms. https://clinicaltrials.gov/study/NCT06423651, Registration Number NCT06423651, 23/05/24.
Alternate-day fasting (ADF) may exert age-related anti-inflammatory effects by modulating key metabolic and immune pathways. This study aimed to investigate the sex-specific effects of ADF on inflammation in middle-aged male and female rats and focused on the Toll-like receptor 4 (TLR4) and leptin signaling pathways. A total of 32 rats (16 males, 16 females; 14 months old) were assigned to four groups (n = 8): ad libitum-fed and ADF groups for each sex. The ADF protocol consisted of 24-h fasting every other day for 2 months. Serum and hypothalamic samples were analyzed via ELISA to measure triglyceride, total cholesterol, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), suppressor of cytokine signaling 3 (SOCS3), leptin, and ObRb levels. TLR4 gene expression in the brain and liver was assessed via qRT-PCR. Two months of ADF significantly reduced body weight and retroperitoneal fat mass compared with those of the control groups (p < 0.001). Cumulative food intake and fasting glucose levels decreased in both sexes following ADF (p < 0.001), and serum triglyceride, total cholesterol, TNF-α, and IL-6 levels (p < 0.001) were significantly reduced. Hypothalamic SOCS3 and leptin levels decreased, whereas ObRb expression increased (p < 0.05). Additionally, TLR4 gene expression was significantly downregulated in both tissues (p < 0.001). These findings suggest that ADF is associated with reduced age-related inflammation and alterations in the TLR4 and leptin signaling pathways. The observed downregulation of SOCS3 and upregulation of ObRb indicate enhanced leptin sensitivity, highlighting ADF as a promising strategy to counteract sex-specific aging-related inflammation and leptin resistance.
Given the contradictory positions regarding masturbation-from its promotion as a healthy practice to its association with negative experiences, which highlight the complexity of this behavior-a bibliometric approach is necessary to help structure this debate. This study aims to map scientific articles indexed in Scopus to identify research production on masturbation, including trends in production growth, sources, authors, countries, affiliations, relevant terms, and collaboration networks. A bibliometric analysis was conducted on 3239 articles published in scientific journals. The selected studies included terms related to masturbation in the title, abstract, and keywords. Articles published between 1840 and 2025 were analyzed, examining their temporal evolution, the most productive authors, countries, and institutions, as well as relevant terms, trending topics, co-occurrence, and collaborations using the R-bibliometrix package. A progressive growth in scientific production was observed, particularly from the 1970s onward. The most productive journals were Archives of Sexual Behavior, The Journal of Sexual Medicine, and The Journal of Sex Research. Scientific output was concentrated mainly in North America and Europe. Trending terms such as "NoFap" and "manosphere" were identified, and limited collaboration networks were observed. The findings highlight the sustained growth and increasing multidisciplinary nature of masturbation research, while emphasizing the need for broader geographical representation and continued development of this field.
The communication skills of healthcare professionals directly influence interventions with patients and their families, and therefore, the quality of care provided. To adapt and validate the CSAS questionnaire in a Spanish university sample of Health Sciences students: Nursing, Psychology, Physiotherapy, Medicine, among others. A cross-sectional design was employed with a sample of 792 participants (21.9% male) with a mean age of 21.12 years. The internal structure, internal consistency, factorial invariance, differential validity by sex, and convergent and discriminant validity of the instrument were analyzed. Normative data were also calculated. Two factors (positive and negative attitudes) with a correlation of -0.71 were obtained, demonstrating adequate fit (GFI = 0.967, NFI = 0.920, SRMR = 0.059) and with an internal consistency of 0.852 and 0.632, respectively. The factorial structure showed clear differences by sex, with different correlations between both factors: -0.77 for males and -0.68 for females. The test demonstrated adequate convergent validity with other similar measures. Differences in scores were observed by sex, with higher values on the scale for males. The Spanish version of the CSAS is a valid instrument for evaluating interpersonal communication skills, both generally and specifically in the field of Health Sciences. The establishment of normative data for the CSAS will allow for the identification of the relative position of evaluated individuals in relation to a university sample.
There are no community-based surveys for the development or assessment of public policies with an ecobiopsychosocial approach for autistic children. This article reports the development of an instrument assessing characteristics of Chilean autistic children, in order to understand how autism manifests in different environments. This study consisted of two stages: Firstly, after a comprehensive literature review, an instrument was designed by health and education professionals alongside autistic individuals and primary caregivers. Secondly, content validation was performed using the Content Validity Index, through the calculation of the Lawshe Content Validity Ratio. Sixty questions were validated, distributed across six subscales: "General Health Profile" obtained a Content Validity of 0.94; The subscales "Sex and Gender," "Autism Diagnosis and Concomitant Pathologies," "Family Income and the Impact of Autism on Socioeconomic Status," "Diet of the Autistic Person," and "Therapies and Schooling" obtained Content Validity Indexes of 0.89; 0.98; 1.0; 0.96; and 1.0, respectively. The Content Validity Index for the full instrument was 0.96. The survey presented demonstrated initial evidence of content validity and may serve as a basis for future psychometric validation. It allows for the assessment of this population in various life aspects, and offers great potential for creating public care policies regarding this community. As this study represents an initial content validation phase, future research should assess construct validity, criterion-related validity, reliability, and cross-cultural applicability.
Background and Objectives: Periodontal diseases are highly prevalent worldwide and have been associated with impaired oral health-related quality of life (OHRQoL). However, the strength and direction of this association remain inconsistent, particularly when sociodemographic and behavioural factors are considered. The aim of this study was to evaluate the independent association between periodontal status and OHRQoL in Bulgarian adults attending a university dental clinic, while accounting for sociodemographic factors and sleep quality, which was included as a clinically relevant behavioural determinant of oral health-related quality of life. Materials and Methods: This cross-sectional study included 504 adult participants (≥18 years) who underwent comprehensive periodontal examination and completed validated questionnaires. OHRQoL was assessed using the culturally adapted Bulgarian version of the Oral Health Impact Profile (OHIP-14), and sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Due to the skewed distribution of OHIP-14 scores, the outcome was dichotomized at the sample median. Multivariable logistic regression analysis was performed to assess independent associations, adjusting for age, sex, education, financial status, place of residence, and sleep quality. Results: Periodontal status, sex, and sleep quality were independently associated with impaired OHRQoL. Females demonstrated lower odds of impaired OHRQoL compared to males (OR = 0.636; 95% CI: 0.428-0.924; p = 0.025). Poor sleep quality was associated with increased odds of impaired OHRQoL (OR = 1.554; 95% CI: 1.041-2.321; p = 0.031). Periodontitis was significantly associated with impaired OHRQoL (OR = 3.526; 95% CI: 2.073-5.998; p < 0.001), reflecting a complex relationship between clinical periodontal status and subjective health perception. Conclusions: OHRQoL is influenced by a multifactorial framework integrating periodontal status, behavioural factors, and sociodemographic characteristics. These findings highlight the importance of incorporating patient-reported outcomes into periodontal assessment and support a biopsychosocial approach to oral health research.
The aim of this study was to evaluate the cost-effectiveness of screening programmes for identifying developmental hip dysplasia (DDH) in children born in England and Wales. The costs and quality-adjusted life-years (QALYs) associated with DDH screening programmes were estimated using a decision-analytic model. Six programmes were modelled from an NHS perspective: 1) Current practice - 'selective' screening: clinical examination with later ultrasound screening (USS) for those with an abnormal examination or specific risk factors (breech birth, first degree family history of DDH); 2) No hip screening: no clinical examination or risk factor assessment; 3) Clinical examination: treatment decisions based solely upon a positive Barlow or Ortolani manoeuvre; 4) Universal USS at birth: USS in the neonatal period in addition to a postnatal check; 5) Universal USS at six weeks: USS in addition to the six-week postnatal check; 6) Sex-stratified screening: clinical examination with selective USS for males and universal USS in the neonatal period for females. The incremental net monetary benefit (INMB) was estimated at a cost-effectiveness threshold of £20,000 per QALY gained. Whether the result was robust to assumptions was assessed using analyses of uncertainty. Secondary outcomes included an estimate of the value of reducing the uncertainty of the decisions. Universal USS (including stratification by sex) was more clinically effective, but at significant additional cost. Current practice was the most cost-effective screening programme in 96% of modelled simulations. Differences in INMB were statistically significant. The reconfiguration of service so that USS does not require additional hospital visits would reduce marginal losses and introduce uncertainty to the conclusion. The benefit of generating better evidence about a reconfigured USS service was valued at £1.91 per live birth, equating to £11 million over ten years. Clinical examination with USS for those with an abnormal examination, or specific risk factors, is likely to be the most cost-effective DDH screening programme in the UK. Further research focused on the costs and efficacy of screening programmes could add value for informing future policy decisions.
To close gaps in implementing care of people with hepatitis B virus (HBV) infection in resource-limited settings, we evaluated the accuracy of a novel liver point-of-care ultrasound (POCUS) protocol for hepatitis (PUSH) among front-line non-radiology healthcare workers in Zambia. At University Teaching Hospital in Lusaka, Zambia, from March to June 2024, we trained four nurses and six physicians with experience in HBV management, but not in ultrasound (US), in the PUSH protocol, which includes visualizing the liver in three windows (epigastric, subcostal and right transcostal) to identify cirrhosis-suggestive features and liver lesions suspicious for hepatocellular carcinoma (HCC). Then, consecutive adult participants with chronic hepatitis B (PWHB) alone or HBV/HIV coinfection underwent PUSH with operators blinded to clinical data. We evaluated the accuracy of PUSH for significant fibrosis and cirrhosis using transient elastography (TE) as the reference standard test (RST) and for liver lesions that were possible HCC using a comprehensive abdominal ultrasound by an experienced radiographer as the RST. Nonparametric analysis of the receiver operating curve (ROC) for PUSH was adjusted for operator type (doctor vs. nurse), sex and HIV status. Among 197 PWHBs analysed, 69.5% were taking HBV antivirals and 27.9% had HBV/HIV. According to RSTs, 17.7% of PWHBs had significant fibrosis, 11.6% had cirrhosis and 3.5% had liver lesions. PUSH had low accuracy for significant fibrosis, with sensitivity of 8.3% (17.5-41.4), specificity of 100.0% (96.1-100) and an area under the curve (AUROC) of 0.54 (0.43-0.65), moderate accuracy for cirrhosis, with sensitivity of 60.9% (38.5-80.3), specificity of 97.7% (94.2-99.4) and AUROC of 0.79 (0.69-0.89), and higher accuracy for liver lesions, with 85.7% (42.1-99.6) sensitivity, 98.4% (95.5-99.7) specificity, AUROC of 0.92 (0.78-1.00). After an expedited training, front-line nurses and physicians treating HBV in Zambia were able to use PUSH to diagnose cirrhosis with moderate accuracy and liver lesions with high accuracy, although confidence intervals around performance estimates were wide. Liver POCUS including PUSH may be useful in HBV management when laboratory systems and TE are lacking.
Mpox remains an ongoing global health concern, driven by an ongoing clade I outbreak in Central Africa, which has caused substantial morbidity and mortality. Despite deployment of the Modified Vaccinia Ankara-Bavarian Nordic (MVA-BN) vaccine, data on the durability of vaccine-induced immune responses remain limited, particularly in African populations, women and people with HIV, highlighting the need for context-specific immunogenicity data. Mpox-Vax AFRIVAC is a prospective, multicentre observational cohort study conducted in Uganda, Tanzania and the Democratic Republic of the Congo (DRC). Adults eligible for MVA-BN vaccination for mpox prevention or who received a first dose within 28 days prior to enrolment are followed for 48 weeks. Serial blood samples are collected to quantify binding antibody responses and assess their durability over time. The primary outcomes are mean geometric MVA-BN-specific antibody titres at week 48 and the rate of antibody decay from week 6 to week 48. Secondary outcomes include antibody kinetics at intermediate time points, factors associated with immune responses, breakthrough infection and vaccine safety. Analyses will use descriptive and longitudinal statistical methods to evaluate immune response trajectories and associated host factors, including HIV status, age and sex. The study is conducted in accordance with the Declaration of Helsinki, registered at the Pan African Clinical Trials Registry (PACTR202601855406764) and publications will be in accordance with the recommendations of the International Committee of Medical Journal Editors. The study has received ethical approvals in Uganda, DRC and Tanzania. Approval for Uganda has been obtained from Uganda Virus Research Institute Research and Ethics Committee (GC/127/1062) and Uganda National Council for Science and Technology (HS5575ES), for DRC from the Institutional Committee of Health ethics (UCB/CIES/PB/001/2025) and for Tanzania from the National Institute for Medical Research (NIMR/HQ/R.8a/Vol.IX/5187). PACTR202601855406764.
Manual chart review (MR) of electronic health records (EHRs) is time-consuming, error-prone, and limits the reproducibility and scalability of real-world data (RWD) research. Automation and standardization using natural language processing (NLP) could improve efficiency and scalability. CTcue is an NLP-based software platform designed to extract structured and unstructured data from EHRs. This study evaluated the accuracy and efficiency of CTcue versus MR in patients with early-stage resectable non-small cell lung cancer (NSCLC). Included were all patients with stage I to III NSCLC who underwent lung resections between January 2018 and December 2021 at the Leiden University Medical Center, the Netherlands. Demographics, tumor characteristics, treatment, and outcomes were collected. CTcue performance was compared with MR using weighted F1-scores, accuracy, precision, and recall for categorical variables and Bland-Altman analysis for continuous variables. Eighty-five patients (70.2% of patients from the manual cohort) were identified by both methods and included in the comparison. CTcue achieved weighted F1-scores >0.85 for seven of 15 categorical variables, including sex, tumor location, and deceased status, although some scores were based on low number of observations in both cohorts. Lower performance was observed for variables with varying terminology in documentation, such as Eastern Cooperative Oncology Group status and pathological N-stage. Continuous variables showed negligible mean differences, indicating good agreement. Survival outcomes were identical in both data sets. CTcue performance for patient selection was lower than anticipated. However, it enables accurate, efficient extraction of structured and unstructured EHR data in early-stage NSCLC. Manual validation remains necessary for variables with varying terminology. Further development of artificial intelligence-based tools-particularly for free-text data extraction-will be crucial to enhance the accuracy and scalability of future RWD research.
Reliable biomarkers for autoimmune encephalitis (AE) are limited, and emerging CSF markers are not incorporated into current diagnostic criteria. Prognostic tools remain insufficient, highlighting the need for biomarkers that support both early diagnosis and assessment of disease severity and prognosis. In this multicenter prospective cohort study, we analyzed clinical data and paired CSF-serum samples from adults with definite AE enrolled in the German Network for Research on Autoimmune Encephalitis registry and the CSF biobank of Hannover Medical School. Of 2,330 screened individuals, 92 patients with anti-N-methyl-d-aspartate receptor (NMDAR, n = 53), anti-leucine-rich glioma-inactivated 1 (LGI1, n = 20), or anti-contactin-associated protein-like 2 (CASPR2, n = 19) encephalitis were included and followed longitudinally for a median of 38 months. Control groups comprised patients with relapsing multiple sclerosis, varicella-zoster virus encephalitis, and noninflammatory neurologic conditions (each n = 30), as well as antibody-positive patients without AE (n = 15), with the groups frequency-matched for age and sex. Kappa free light chain (KFLC), neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), and cytokines were measured in paired CSF-serum samples obtained at baseline and during follow-up. Disease severity and disability were assessed using the Clinical Assessment Scale in Autoimmune Encephalitis (CASE) score and the modified Rankin Scale (mRS). Intrathecal synthesis of KFLC was detected in 94% of anti-NMDAR, 50% of anti-LGI1, and 53% of anti-CASPR2 encephalitis cases, demonstrating higher diagnostic sensitivity than CSF-restricted oligoclonal bands or pleocytosis. Diagnostic specificity across pooled control groups was moderate at 44% but reached 90% when compared with noninflammatory neurologic controls. CSF NfL z-score levels were strongly associated with baseline disease severity, with each 1-standard deviation increase corresponding to an approximately 10-point higher CASE score, independent of clinical covariates (β = 0.61). Longitudinal changes in NfL concentrations in CSF and serum were associated with disease severity and neurologic disability at follow-up (CASE score: adjusted R2 = 0.401; mRS score: adjusted R2 = 0.203). GFAP and cytokines showed limited diagnostic or prognostic utility. Intrathecal KFLC synthesis represents a highly sensitive CSF marker that supports early suspicion of autoimmune encephalitis and prompts antibody testing. NfL provides robust biochemical information on baseline disease severity and longitudinal changes that may aid prognostic assessment across AE subtypes.
Social inequalities in mortality persist in Germany despite high universal health coverage. Yet no study has simultaneously examined sex-specific differences in accumulation, age modification, and life-stage variation in the association between social disadvantage and all-cause mortality across the adult life-course. We conducted a longitudinal life-course study using 28 years of data from the German Socioeconomic Panel (SOEP; 1996-2023), comprising 112,006 adults and 660,480 person-wave observations. Low socioeconomic status (low-SES), an indicator of social disadvantage, was measured as the number of years spent in the lowest 20% of a composite SES index of education, occupation, and income. Cox proportional hazards models were fitted to estimate (1) accumulation, (2) age-modification, and (3) life-stage variation in the social disadvantage-mortality association for women and men. Results are reported as adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). Over 684,295 person-years of follow-up, 4,974 deaths occurred. Cumulative social disadvantage was associated with higher mortality risk for both sexes. Among women, each additional year spent in social disadvantage at age 50 was associated with a 13% higher mortality hazard (HR = 1.13; 95% CI: 1.07-1.19). The accumulation gradient was steeper among men (15%; interaction HR = 1.02; 95% CI: 1.01-1.04). The age-modification model indicated that the strength of the social disadvantage-mortality association attenuated with age, but more gradually for men than for women. In the life-stage model, stronger associations were observed in emerging adulthood for women (ages 16-29: HR = 1.34; 95% CI: 1.05-1.71) and in mid-adulthood (ages 45-64: HR = 1.13; 95% CI: 1 .03-1.24) and late adulthood ( ages 65 + : HR = 1.14; 95%CI: 1.00-1.29) among men. An accumulation of social disadvantage increases mortality hazard for both sexes, but is higher for men. Association decreases with age, strongest in emerging adulthood for women and mid-to-late adulthood for men. These findings underscore the importance of life-course-informed and gender-responsive public health actions to reduce persistent social inequalities in mortality in Germany.
Young adults, especially men, may experience delays in hypertension diagnosis, treatment, and control. We estimated the time to first diagnosis of hypertension in young adults by sex and identified factors associated with hypertension diagnosis. Using electronic health records from Kaiser Permanente Southern California, we identified adults, aged 18 to 39 years, without history of hypertension, and with high blood pressure (BP) (systolic BP ≥140 or diastolic BP ≥90 mm Hg), based on an average of 3 BPs from separate, consecutive outpatient visits within 2 years of each other between 2009 and 2016 and followed through 2019. We estimated the time to first hypertension diagnosis and identified factors associated with diagnosis using Cox proportional hazards models. Among 2443 young adults (mean age, 31 years; 57% men) with high BP, 37% were diagnosed with hypertension during a median of 5.9 years. Delays in hypertension diagnosis were observed for both men and women, with a median of 1.8 years to diagnosis. Compared with women, men received their diagnoses later (percentage of diagnosis: 30% versus 47%; median time to diagnosis: 2.3 versus 1.4 years). Following their diagnosis, 80% initiated antihypertensive medications within 1 year. Factors associated with a delayed diagnosis of hypertension included being a man, being younger, having lower BP, having a lower body mass index, and the absence of dyslipidemia or (pre)diabetes. Young adults, especially men, are at a high risk of delayed hypertension diagnosis, emphasizing the need for health care system-level interventions to improve the recognition, diagnosis, and treatment of hypertension in this population.
Especially, the coxsackievirus B group of enteroviruses has been linked to the development of islet autoimmunity and type 1 diabetes in genetically susceptible individuals. Our aim was to study the possible associations of 10 different microbial infections with islet autoimmunity in a large international prospective study. In a nested case-control study within the TRIGR study, follow-up serum samples from 240 islet autoantibody-positive case children and 436 age- and country-matched control children were analysed for IgG class antibodies against 10 different respiratory and gastrointestinal microbes using an enzyme immunoassay, and for neutralising antibodies against all six coxsackievirus B types. The samples were obtained at several time points prior to and at the time of seroconversion for multiple islet autoantibodies. All children had a first-degree relative with type 1 diabetes, and they carried risk-associated HLA-DQ alleles. Coxsackievirus B5 was associated with an increased risk of islet autoimmunity (OR 2.22, 95% CI 1.29-3.80, p = 0.004, corrected p = 0.024), which remained after adjustment for HLA, sex, and maternal type 1 diabetes. This association was particularly seen for infections occurring more than 12 months (OR 2.02, 95% CI 1.06-3.84, p = 0.032) and 0-6 months (OR 2.66, 95% CI 1.11-6.35, p = 0.028) before the first detection of multiple islet autoantibodies. After correction for multiple comparisons, none of the other viruses showed an association with islet autoimmunity. This study supports previous evidence of the risk association of coxsackievirus B infections. These results support the role of certain virus infections as possible modulating factors in the pathogenesis of type 1 diabetes.
HIV/AIDS has posed continuous public health challenges for decades, impacting both physical health and socioeconomic development in sub-Saharan Africa, particularly among key populations like men who have sex with men (MSM). This study aims to determine the key factors associated with the prevalence and willingness to take HIV services among MSM in a Northern Nigeria state. The study used a cross-sectional survey of MSM in three local government areas in Kano state. HIV prevalence was measured with self-test kits, and willingness to use services was assessed via a 17-item questionnaire. Snowball sampling was used, with data collected by trained assistants and community leaders. Data were analysed using bivariate and multivariate logistic regression in IBM SPSS V.28.0. HIV prevalence was 12.3%; MSM in Fagge (adjusted OR (AOR) 4.173; 95% CI 1.193 to 14.595, p=0.025), those not abusing drugs (AOR 5.969; 95% CI 2.412 to 14.770, p<0.001) and those engaging in vaginal sex in the last 3 months (AOR 4.140; 95% CI (1.402 to 12.224), p=0.010) had higher odds to contract HIV. The major reason for taking HIV tests was to know their status (84.0%), while the major obstacle stopping them from assessing HIV services was stigmatisation by providers (25.1%). Similarly, willingness to uptake HIV services was 47.4%; MSM in Tarauni (AOR 92.453, 95% CI 30.541 to 279.876, p<0.001), those who inject drugs (AOR 3.592, 95% CI 1.207 to 10.695, p=0.030), engage in anal sex (AOR 0.075, 95% CI 0.051 to 0.302, p<0.001) and use condoms regularly (AOR 2.731, 95% CI 1.279 to 5.829, p=0.009) had higher odds of accessing HIV services. This study emphasises the critical need to address barriers and improve HIV prevention and treatment services for MSM in northern states of Nigeria.
Colorectal cancer (CRC) remains one of the leading causes of cancer-related mortality worldwide, with incidence steadily increasing in China. Early detection through screening significantly reduces morbidity and mortality. However, awareness and participation remain inadequate, especially in rural populations, who account for nearly 39% of China's total population. Understanding awareness levels and associated factors is essential for developing targeted interventions. A population-based cluster cross-sectional study was conducted between September 2022 and March 2024 in two rural villages in Beijing and Henan Province. All permanent residents were eligible for this observational assessment of CRC awareness, for this observational assessment of CRC awareness; when the number of eligible residents exceeded the required sample size, participants were randomly selected from household lists provided by local village committees to ensure proportional representation across age and sex. Data were collected using a standardized questionnaire assessing knowledge of CRC risk factors, preventive measures, early symptoms, and screening methods. Logistic regression was performed to identify factors associated with high awareness, defined as a total score ≥ 90 on the awareness scale. Of the 2,091 participants, 60% demonstrated high awareness of CRC screening. Recognition of major risk factors such as advanced age (83.5%), colon polyps (88.1%), and family history (87.3%) was high, as was awareness of protective factors like dietary fiber intake/whole grains/yogurt (85.5%). Awareness of early symptoms such as blood in the stool (88.4%) and abdominal pain/incomplete evacuation (95.5%) was strong, but recognition of fatigue and anemia was lower (77.4%). Awareness of fecal occult blood testing (82.0%) and fecal genetic testing (85.1%) was slightly lower than for colonoscopy (86.7%). Logistic regression showed that age, gender, education level, alcohol consumption was significantly associated with higher awareness (P < 0.05). This study provides the first evidence of CRC awareness among rural populations in Northern China, revealing knowledge gaps in non-specific symptoms and non-invasive screening methods. Despite relatively high awareness, uptake of screening remains limited, indicating barriers such as access, cost, and cultural factors. Tailored education, accessible screening, and behavioral interventions are needed to improve prevention and early detection in these underserved communities.
Most people with alcohol use disorder (AUD) do not receive treatment. Few digital evidence-based treatments have been tested among community-based samples of people with AUD. The present trial of Computer-Based Training for Cognitive Behavioral Therapy (CBT4CBT) (1) assessed CBT4CBT usability and acceptability and (2) explored alcohol-related outcomes by study condition in a non-treatment sample of people with AUD. For the current two-arm clinical trial, a non-treatment sample of people with lifetime AUD and current heavy drinking was recruited using ResearchMatch.org and randomized (3:1) to the CBT4CBT program or an assessment-only control, stratified by sex (N = 160 total; CBT: n = 109; Co: n = 51). Study assessments included post-intervention acceptability ratings and self-reported alcohol-related measures administered at baseline, post-intervention, and 1-month follow-up. Participants were 68.1% female and 31.9% male, in their early forties (M = 42.6, SD = 15.7, range 19-76 years). Most participants identified as white (65.0%) or Black (27.5%) and non-Latinx (89.4%). Acceptability ratings and usability measures for CBT4CBT were favorable and comparable to studies among clinical treatment samples. Participants in the CBT4CBT group demonstrated faster reductions in the percentage of drinking days and were significantly less likely to report any heavy drinking days than those in the control condition at 1-month follow-up. The CBT4CBT group reported higher recovery scores than the control group. The present study provides benchmark data on the use of CBT4CBT in a sample of people with AUD not receiving treatment. Findings have important clinical and research implications for expanding the reach of evidence-based addiction treatment beyond traditional treatment settings.
Epilepsy is a major public health challenge affecting individuals of all ages, especially in low- and middle-income countries (LMICs). Reliable prevalence projections are critical for healthcare planning and resource allocation. This study aimed to forecast the prevalence of epilepsy and its trends in LMICs by age, sex, year, and income level by 2050. Using data from the Global Burden of Disease Study (GBD) 2023, we projected the prevalence and number of idiopathic and secondary epilepsy cases in LMICs from 2024 to 2050. We developed a hybrid deep neural network (DNN)-Transformer framework that integrates Poisson regression and Autoregressive Integrated Moving Average (ARIMA) models for prevalence projection. Decomposition analysis was applied to quantify the contributions of population growth, aging, and prevalence change to the increase in epilepsy cases. Dementia-attributable epilepsy was independently projected to address secondary causes not included in GBD 2023. By 2050, the age-standardized prevalence rate (ASPR) of epilepsy in LMICs was projected to reach 907.22 per 100,000 [95% uncertainty interval (UI) 731.01-1083.56], a 33.32% increase from 2023, with cases rising to 72.04 million (95% UI 57.86-86.23), a 58.68% increase. The ASPRs of idiopathic and secondary epilepsy were estimated at 323.11 and 584.10 per 100,000 in 2050, respectively, with the increase in secondary epilepsy being more than 7-fold that of idiopathic epilepsy since 2023. The ASPR of secondary epilepsy due to neonatal disorders was projected to rise by 65.76%. Model validation demonstrated good predictive performance (root mean squared error <0.001). From 2023 to 2050, the increases in idiopathic and secondary epilepsy cases were forecast to be highest in low-income countries (LICs; 76.12% and 241.50%, respectively), with growth declining as income levels increased. Population growth (21.40%) primarily drove the increase in idiopathic epilepsy cases, whereas changes in prevalence (59.89%) predominantly drove the rise in secondary epilepsy cases. Dementia-attributable secondary epilepsy was projected to reach 3.40 million cases by 2050. We forecast a continuous increase in the prevalence and number of epilepsy cases in LMICs through 2050, with secondary epilepsy increasing more rapidly than idiopathic epilepsy. LICs may exhibit the greatest increases over the next three decades, necessitating targeted interventions and further investigation.